Acute Kidney Injury is a sudden and recent reduction in a person’s kidney function. It is estimated that approximately 100,000 deaths are associated with AKI each year with up to 30% of these being preventable with the correct care and treatment. NCEPOD (2009)
Aintree University Hospital NHS Foundation Trust has directed its attention to improving the care delivery of patients who develop AKI for approximately five years. The STOP-AKI project was triggered following a mortality analysis at the trust and joint collaboration with the Institute of Healthcare Improvement, Boston, USA. During this journey, Aintree have utilised quality improvement methodology to examine and refine each of the recommended investigations and interventions to ensure that patients who develop AKI are treated timely and effectively.
The Advancing Quality Alliance (Aqua) Advancing Quality (AQ) programme aims to ensure high reliability and reduce variation, through a structured approach to embedding evidenced-based care; enabling the highest quality of care to be provided to every patient, every time. The AQ AKI measures were devised in 2015 by a group of North West England clinicians who share a specialist interest in the disease area. This process was supported by the British Medical Journal (BMJ), and aimed to enhance the care that AKI patients receive though prompt diagnosis, action and referral to specialist services.
Aintree University Hospital NHS Foundation Trust are currently utilising the AQ AKI measure set to monitor care delivery for patients with AKI.
Read this case study here.
AQ: Improving Care for Patients with Sepsis in an Acute Trust
Southport and Ormskirk Hospital NHS Trust provides acute hospital services to 258,000 people across Southport, Formby and West Lancashire. Acute care is provided at Southport and Formby District General Hospital and Ormskirk and District General Hospital. Sepsis accounts for around 1,200 acute admissions to the trust each year.
AQ: Aintree Improvement Journey for Patients with Alcohol Related Liver Disease
Aintree University Hospital NHS Foundation Trust joined the Advancing Quality (AQ) programme at its launch in 2008 and is currently participating in eight clinical focus areas (CFA), this includes Alcohol Related Liver Disease (ARLD).
AQ: Reducing Avoidable Harm through Patient Assessment & Escalation
In patients who are, or become acutely unwell in hospital, there is evidence that deterioration is not always recognised or it is not acted on rapidly enough (NICE, 2007). The Walton Centre NHS Foundation Trust wanted to improve observation recording, recognition and response to deteriorating patients using the NEWS assessment tool.
AQ: Reducing Mortality in Community Acquired Pneumonia (Liverpool University Hospitals NHS Foundation Trust)
The NICE (2014) guidance publication ‘Pneumonia in Adult: Diagnosis & Management’ covers diagnosing and managing Community Acquired Pneumonia (CAP) in adults. Its aim is to improve the accurate assessment and diagnosis of pneumonia to help guide antibiotic prescription and ensure that people receive the right care. It estimates a mortality rate between 5% and 14% for patients admitted to hospital with CAP.
AQ: Serum Lactate in the Treatment of Sepsis
he Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT) identified an opportunity to improve the early diagnosis of patients with sepsis. Evidence suggests that the sickest sepsis patients have high levels of serum lactate. Timely measurement of serum lactate levels in patient pathways can improve early diagnosis which will lead to improved outcomes.
AQ: Embedding Early Assessment In Out of Hours Primary Care
Sepsis and deterioration is a huge clinical problem and 70% of sepsis cases originate in Primary Care. In the last five years we have experienced a culture shift in primary care; from seeing sepsis as an acute condition that is difficult to detect, to recognising the need to actively assess patients where infection could be causing significant illness or deterioration.
AQ: Effective Management of Frailty in Hip & Knee Replacement (Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust)
NHS England defines frailty as ‘where someone is less able to cope with and recover from accidents, physical illness or other stressful events’1. As the population ages, so frailty rates increase, presenting challenges to care systems. Elective hip and knee replacement patients undergo pre-surgical checks to ensure they are able to cope with their procedure.
AQ: Improving the Management of Acute Kidney Injury (AKI)- Role of the AKI Pharmacist
The 2009 NCEPOD report, Adding Insult to Injury, reviewed outcomes for patients with acute kidney injury (AKI) in hospital. The report found that medication was the most common AKI risk factor not assessed and only 15% of patients had their medication altered to renal doses. The national AKI programme Think Kidneys advises that medicines optimisation is essential to reduce the risk of AKI and mitigate its severity if it occurs.
Sepsis is a life-threatening condition which has in recent years become a high priority for healthcare providers. Early recognition and prompt management of sepsis can improve outcomes for patients, reducing the risk of mortality and morbidity. This could potentially save 14,000 lives and result in 400,000 fewer days in hospital for patients every year, according to estimates by the Sepsis Trust.
AQ: A Collaborative Approach to the Management of Acute Kidney Injury (AKI)
Southport and Ormskirk Hospitals NHS Trust has established a steering group to improve care for patients with AKI. The group is using the care bundle data from the Advancing Quality Alliance (AQuA) Advancing Quality (AQ) AKI programme to monitor care delivery for patients with AKI and to provide a framework for improvement.
AQ: Improving the Ultrasound Scanning Process for Patients with Acute Kidney Injury
Acute kidney injury (AKI) may sometimes be caused by an obstruction in the urinary tract, which can require treatment with a nephrostomy. It is important that people with AKI who are suspected of having a urinary obstruction receive an ultrasound scan early in their management, as outlined in national guidance (NICE, 2019).
AQ Insight Reports: Case Study
More patients are admitted to hospital as a result of pneumonia in the north of England compared to the south. In the North West in 2019, the rate per 10,000 population was 58.5. To help reduce unwarranted clinical variation and health inequality, capture best practice and share evidence-based insights to AQ members across the North West, the AQ team created ‘Insight Reports’.